Verify Insurance Eligibility

1 If there are significant discrepancies between the data provided in the order and the data provided by the carrier, or if an IPA message has to be displayed, the Eligibility Verification dialog box appears. (For more information about eligibility verification, see Eligibility Verification.)

The data from the order appears in the User Entered column, and the data from the carrier appears in the Eligibility Returned column.

Note: Even if the Eligibility Verification dialog box does not appear, the message Acceptable Match appears on the requisition if eligibility verification was performed and the information in the order matches the information from the carrier.

Do one of the following:

• Proceed with the order as is. If no information about this patient is available from the carrier, or if the carrier indicates that the patient is not currently covered, but all of the information about the patient and carrier is correct, click Continue.

• Identify the correct information. If there are discrepancies between the information in the order and the information from the carrier, follow these steps:

a Click the option button next to each piece of information that you want to use.

For example, if there are discrepancies with the patient’s address and zip code, you might click the option button in the User Entered column for the address and the option button in the Eligibility Returned column for the zip code, depending on which information is currently accurate.

You can also click Select All to select all of the option buttons in a particular column.

b Click Continue.

Notes:   • If the patient’s first name as specified in the order does not match the first name provided by the carrier, this is not flagged as a discrepancy. The first name from the order is always used. • If the patient is the guarantor (that is, if Relation is set to Self), any changes to the patient’s last name or address are made to both the patient and guarantor information. If the patient is the guarantor’s spouse or dependent, any changes to the last name affect only the patient information; any changes to the address affect only the guarantor information.

• Modify the order. If the carrier is incorrect, or if you need to change any of the displayed information manually, follow these steps:

a Click Edit.

b Make any appropriate changes by clicking Edit in the Patient Information or Insurance area, click OK, and then click Next.

If you change the patient’s first or last name, date of birth, zip code, primary carrier, primary insurance ID, secondary carrier, or secondary insurance ID, eligibility verification takes place again. If you do not change any of that information, eligibility verification does not occur again.

2 If the carrier requires a diagnosis, go to Specify a Diagnosis. Otherwise, go to Specify a Test